Black Mark
by Calyxo
Summary: A Starfleet medical intern loses his first patient.


Maximillian Pohl and four of his classmates interned aboard the USS _Paracelsus_. The hospital ship was extraordinarily busy and served diverse populations, a kiln for newly minted doctors; those who didn't crack became much harder to break.

The hours were brutal, the resident doctors indifferent, and the five newest contenders in the constant melee closed ranks. Clawing for the highest marks at Starfleet Medical had made them mortal enemies. Life on the _Paracelsus_ crafted them into fast friends still free to hate each other when it was convenient.

Thorl was the first among them to lose a patient. The other four gathered in the ship's lounge to offer him what comfort they could. Thorl brought a full pint of Andorian ale to his blue lips with steely determination.

"He was old. Multisystem organ failure. He was done," said Simone.

Thorl swallowed once, tilting the glass up higher.

Simone looked at Max, who cleared his throat. "The Necedrol was the way to go," he said with conviction.

The level of liquid in the glass continued to decrease.

Max and Simone looked at Setat. The Vulcan stared back at them silently. Emotional support wasn't his strong suit.

Thorl drained the last of the glass, stubbornly refusing to take a breath until the last of it was gone.

"He's gonna make himself sick," Owen muttered.

Thorl slammed the heavy pint glass down on the counter. "I am already sssick," said the Andorian raggedly, taking great lungfuls of oxygen. "But it will passss. I want sssomething that will not. A mark. For him."

The other four looked at each other. "You mean, like...a tattoo?" hazarded Owen. "There's a place on deck eight-"

"No. Not from ssstrangersss." Thorl wiped his mouth with one hand. "One of you."

Silence reigned. They were all egotistic overachievers anxious to show off, but they all knew this. No one wanted to volunteer; the uneasy peace in their tightly-knit group suffered no celebrities.

"Straws?" suggested Simone eventually.

Drinking straws were gathered and cut while Thorl began another pint. Max drew the shortest. He knew better than to smile.

Everyone contributed. Simone bought the design program. Owen and Setat used their weekly ration of replicator credits to generate the needle and the ink. They got the unsteady Thorl into a little-used isolation ward and prepped before he finished his second drink, and the others watched while Max etched a perfect Telev's Bane onto the Andorian's shoulder, just above the carapace line.

* * *

Max woke up when Simone rolled away from him. He kept his quarters dim, but he could still make out the new shadow of the Starfleet Medical crest Thorl had outlined on her shoulderblade.

He brushed his fingertips against the small of her back. She made an annoyed sound and stood up, out of range. "Don't," she said shortly, and began to retrieve her clothing.

Max sat back obediently. Simone had only two temperature settings; he'd learned years ago not to take it personally. "When's the inquiry?" he asked.

"In an hour." She was half-dressed already, wrapping her long dark hair into a smooth braid with rapid motions. "You coming?"

"I've got a shift," he replied. "You'll do fine."

She zipped up her jacket forcefully. "You think?"

Too late, Max's danger sense activated. "You're not really worried, are you?" he asked cautiously. "The woman came in without a pulse. If you hadn't gotten her up and running for a few minutes there wouldn't be an inquiry. They can't pin this on you."

She stared at him for several seconds as if he were stupid. Max always hated that, but never more than when he felt stupid.

"You're such an asshole," she pointed out, snatching her bag.

"Have fun," he replied brightly.

She left.

"Shit," said Max.

* * *

The _Paracelsus_ residents treated their intern pool to a party to celebrate six months on the job. As agreed, Max met Simone outside her door. Her dress and her lips were both a deep, rich red.

"You look nice," he said in a surprised tone.

She punched him in the shoulder. He kissed her cheek.

"How long do we have to stay?" he asked petulantly as they walked toward the lounge.

"Until I get drunk enough to go home with you," she retorted, slipping her arm through his. "Could be a while."

The lounge was packed with medical staff of all ranks, marinating in synthehol. Simone and Max split up at the door to locate and greet their respective residents. Social opportunities to impress one's assigned mentor were few and far between; it could mean the difference between a flagship posting and a tramp freighter.

Max had to wait in line for Dr. Murchada; he watched Simone approach Dr. Leighton across the room and trade smiles and words. Simone was poised, articulate and brilliant, and yet when the next intern in line sought to displace her, Simone yielded her position without resistance. She should have capitalized on Leighton's attention, mentioned the man's research grant; instead, she'd only gotten a hello and a name exchange.

He had time to help her fix that, he reminded himself. By the time their internship ended, she would be as fearless in person as she was in surgery, and they'd get the joint posting they wanted.

Max did his duty, got a laugh out of Murchada and the implied promise of a complex surgery assist, then joined Simone and the others at the edge of the room.

"You made it laugh," Thorl said suspiciously. "Did you ssspeak of torturing sssmall animalsss?"

"Why would he need small animals when he's got us?" asked Owen morosely. Simone snickered into her drink.

"Dr. Murchada is a very efficient human," remarked Setat dispassionately. "I am sure he only tortures interns when it is convenient to the task at hand."

"Speaking of tasks," said Max smugly, prompting a quiet groan from Simone, "he's going to let me assist on a spinal graft. Think I'll turn in and get a head start on the research in the morning."

Simone leveled a stare at him that didn't match the light amusement in her voice. "We just got here, Max. Even Owen's still sober."

"Nuh uh," said Owen defensively.

"Don't you think these things have become a waste of time?" asked Max impatiently. He addressed the group, but his eyes locked with Simone's the longest. "Every month we all show up, tithe a little worship to the residents and grab up whatever they drop. After that, what's the point?"

"To blow off sssteam," answered Thorl.

"I'd have less steam if I could get ahead of my paperwork," groused Max.

"There are reasons to socialize beyond career advancement, Max," Simone said testily.

Max made a derisive sound. "We socialize twice a week, minus royal oversight." He cast a glance at the residents still holding court. "This isn't about socializing. This is about them making us feel like assholes."

"At least you're in your comfort zone," consoled Simone.

Max raised his eyebrows. "Ouch," he commented. "Come on. A party to celebrate surviving six months? None of you find that condescending?"

"Surviving this long wasn't easy for all of us, Max," Owen murmured.

"Six months is an arbitrary milestone," Setat intoned coldly. "It is merely an excuse to convene and reinforce the bonds of community that support us all in times of stress. It is reasonable to seize upon any excuse available to perform this vital function."

Max chuckled. "Alright, whatever. You guys stay and bond. I'm going to get some sleep." He left, the glares of the others hot on his back.

Simone stopped him in the hallway outside the lounge.

"You need to think about what you're doing, Max," she said seriously.

"Me?! You think I'm being antisocial because I'd rather take a shot at six hours of sleep than whine about how hard everything is?"

"I think you're being shortsighted," she said, sidestepping his insult. "We're your friends, Max. You need to figure that out."

"Don't start with that," snapped Max. "I worked four doubles in the last six days. My casework has been two weeks behind since the day I started. I may not be part of your little tattoo confederation, but it's hard for me, too."

"Friends make it easier," she said simply. "You need them."

"You need them," he corrected angrily. "I only need you, and some fucking sleep, and I can guess which one I'm - "

The sound of the ship's alarm klaxon made him jump. He and Simone stared at each other, their argument forgotten.

 ** _"All medical personnel: This is not a drill. We are approaching a mining outpost in a state of emergency. Casualties are incoming for treatment. All medical personnel, report to stations."_**

The party guests began to stream out of the lounge, detoxed and drained of their levity. The residents came first, moving with grim purpose toward the turbolifts. Max and Simone joined them, crammed into the back together. Her heartbeat was fast against his side. He let his cheek brush against her temple in silent communion. She rested a hand on his arm.

Prep cubicles were waiting for them. Max and Simone replaced their finery with sterile scrubs, moving at the same swift, efficient pace. Their stations were not adjacent; they parted ways as they entered the infirmary and Max quickly lost sight of her. His first patient arrived, then, beamed directly into the hospital bed, and Max lost sight of everything else.

 **Human female. 28yo.**

 **Weak pressure.**

 **Erratic heart rate.**

 **OSAT 36%.**

 **Left leg crushed below the knee.**

 **Compound fracture, right humerus**

 **Anterior chemical burns, abdomen to ankle.**

Adrenaline only made him sharper. The bed whirred into action under his guidance as he wrested control of each problem. He intubated her by hand as the bed applied painkillers and stimulants to steady the heart. Her eyes were wide and blue, unfocused; he barely noticed.

He sealed her burns and created a circulatory shunt for the flow to the ruined leg. The shunt interfered with the sealant. He used a microsuture to close the tiny gap. She blinked spastically, her body twitching underneath the diagnostic arches. Max engaged the restraints and started to set her arm.

Her heart rate refused to even out. Her blood pressure rose, then began to sink. Alarms sounded.

Max darted back to the panel, a slight frown on his face. The scanner showed no damage to the cardiac musculature. It had to be shock. He administered stabilizers. She went into arrest.

His frown deepened. He engaged the defibrillators. The first jolt got him nothing. The second created two weak, lonely blips on the heart monitor. The bed let him have two more without result before the automatic shutout kicked in.

* * *

Losing a patient didn't relieve him of his emergency shift. Murchada had gotten word, routed only non-critical cases to Max, but there was work to be done. Two solid hours and change passed before the interns were released from duty, and Max reported to Dr. Murchada's office to explain himself.

"Dr. Pohl." Murchada looked up as Max came in. "You look like hell, son." There was no concern audible in that voice, only amused curiosity. "What was the final disposition on your patient, em," he paused and dug through the stacks on his desk until he found the appropriate PADD. "Ruth Emery?"

Max swallowed, but the odd bitter tang in his mouth refused to leave. "She died, sir," he said hoarsely.

"Yes, yes," said Murchada impatiently. "I saw that - and welcome back to the mortal plane, Dr. Pohl, we're all glad you could join us - but what did she die of? Heart failure? That's what's in your notes," said the resident.

Max couldn't remember making notes. The smell of singed clothing was improbably strong. "Yes, sir," he said weakly.

Murchada made a thoughtful sound. "Interesting. I'll set up the M&M for tomorrow, after we've gotten the rest of these miners out of here. Take the day, doctor, and get yourself cleaned up." Amused curiosity had given way to amused distaste. "That's all," he prompted, tossing Ruth Emery's PADD back on the stack with a practiced motion and going back to his terminal.

Max shed the filthy scrubs into the prep cubicle's recycler. He showered, shaved, dressed in clean civs, all the rituals that normally made him into a person. His autopilot took him to an open desk in the cramped, shared office area to work on case reports, but his mind wouldn't focus. He retreated to his quarters, blank inside.

Simone arrived a few minutes after, and Max could tell from how she hesitated near the door that she knew.

She approached, laid a hand on his arm. "Want a drink?"

"No," said Max.

She took him to the lounge and bought him something potent and expensive. Max stared at it for a while. He distantly appreciated the effort she was making. Simone was not innately nurturing.

The other three trickled in, one at a time, no doubt responding to a Simone-initiated distress call. They coagulated around him, drank, talked with each other about things unrelated, waiting, but his monosyllabic answers and silence gave them no purchase. A couple of hours later, it was only Simone and his drink again.

She picked up his glass and emptied it in a single draught. "Want to walk me home?" she asked.

"No," said Max.

Simone took him back to his quarters instead. He stood motionless in the center of the room while she cued music. She stepped in close, and the clean, sweet smell of her hair reached into him and flipped a switch; Simone had been home to him for too long. He pulled her against him and brought his mouth to hers. She tasted potent and expensive.

The remembered scent of burning cloth raked itself across his awareness without warning. Max groaned and pulled away from her, sitting heavily down on his bunk and resting his elbows on his knees. "It shouldn't have happened," he said in a low, tight voice, hands lacing together tightly. "I did everything right."

She touched his shoulder. He shrugged her off.

"That's how it goes," said Simone softly. "I felt the same way."

"You were too slow," he said.

The emotional temperature in the room dropped several degrees.

"What?" she asked sharply.

"Your patient," he said with the cold finality of someone who'd already stepped off the cliff minus a line and was determined to make his landing as spectacular as possible. "If you'd pushed the stimulants first she would have made it. Setat didn't wait long enough to put on the chill pad. Thorl went too easy on the Necedrol. Owen was too busy administering painkillers to solve any actual problems." He was on his feet. Shouting felt so much better than the cold blankness before. "You all screwed yourselves. I did everything RIGHT."

He and Simone stared at each other.

"Not everything, sweetheart," she murmured, and left.

* * *

Morbidity and mortality inquiries were a way of life on the _Paracelsus_. Any patient who died in the hands of the interns merited one, but even the residents weren't immune. They were usually open attendance, but long hours meant only the truly fascinating cases pulled a crowd.

Max showed up ten minutes early, meticulously groomed in his dress greys. The gallery held three bored-looking interns. No one else joined them. Max was unsurprised; Simone's kit had magically disappeared from his room while he was out for breakfast.

The inquisitors arrived two minutes late, Drs. Murchada and Leighton. Max came to attention as the two took their seats.

"Dr. Pohl," began Murchada without preamble, "we're here to discuss the case of ... " he checked his PADD, "Ruth Caroline Emery. Dr. Leighton and I have reviewed the diagnostic record and your notes. Do you have anything to add before we begin?"

Max held his ground. "No, sir."

The doctors went through the entire procedure one step at a time, hammering him with questions about his decisions at each point. Max answered swiftly and clearly. He had no doubts about why he had made his choices. Now it only remained to discover which one had been incorrect.

The questions wound down as they reached the end of the record. Leighton and Murchada looked at each other. Leighton shrugged.

"Dr. Pohl," said Murchada, "we find no fault with your diagnostic or treatment methods in this case. You're dismissed."

Max stayed at attention. He had been sure they would find something he'd overlooked. "Sir...are you sure?" His voice was mostly steady.

Murchada looked up from his PADD. "If you're looking for absolution," said the resident dryly, "there's a chapel on deck two. Do you have something relating to this case you have neglected to mention?"

"No, sir," said Max reluctantly.

"I didn't think so, and there's three more of you interns to disassemble before lunch. So go forth, Dr. Pohl, and sin no more." He made a get-lost motion at Max. "Dismissed."

* * *

Work and Simone had always contrived to rob Max of a good night's sleep. Now he chased sleeplessness with single-minded purpose, intent on finding out what had gone wrong with Ruth Emery. The case was closed. No black marks appeared on his record. Max was the only one who couldn't let it go.

His resident said nothing, but his workload increased threefold. Max despised coffee, but he learned to live on it, an ever-present bitter taste in his mouth. The grueling pace devoured him, shift, reports, Emery research, a few hours of sleep and back on shift, but Max met it head on. His schedule had no time in it for grief.

The _Paracelsus_ had an extensive medical library. Max loaded PADDs with relevant texts so he could pore over them regardless of location, methodically examining and dismissing each biological system and its points of failure as the cause of Emery's death. He made a second pass, and a third.

Sleep became a nuisance. He prescribed himself meds and eyedrops to counter the side effects of the caffeine and wrung another research hour out of each day. Habit kept his hair combed and his cheeks smooth, but the shadows in and under his eyes belied the meticulous grooming; he was beginning to fray.

His efforts availed him nothing. Frustrated, Max spent hours designing a holoprogram with the details of the Emery case so he could test possible theories. Programming was not his forté, but he couldn't risk an error. When it was finally complete, he submitted the request for the holodeck session. Four minutes later, Murchada denied it.

Other interns made way for him as Max crossed the rows of desks to the resident offices. He hit the override for Murchada's door and stepped inside without bothering to buzz first.

Murchada didn't look surprised, but the older man never looked surprised. "Is there a problem, Dr. Pohl?" he asked.

"Give me the deck time I asked for," demanded Max, his right hand curled into a fist.

"No," replied Murchada.

The simple denial infuriated Max far more than a bloated rant. His hands came down hard on the edge of Murchada's desk and he leaned forward intently. "I'm caught up on my casework," he growled. "You've got no valid reason to deny me."

"Watch me," said Murchada.

Max backhanded the nearest pile of PADDs from Murchada's desk, the dry plastic clatter loud against the wall, then muffled by the carpet. "What's wrong with you? She deserves more than- than twenty seconds of half-assed attention from some callous fuck who can't remember her name without reading it on a screen! She needs more that that!"

"She's dead," the resident said evenly, "and you're suspended until further notice. Now get out of my office, Lieutenant, before I call security."

* * *

Simone found him later, sitting on the floor in a dead-end corridor of the supply wing. Two weeks had passed since she and her kit had vanished from his life. It seemed much longer than that.

"Hello, Maximillian," she said softly. Max opened one eye as Simone sat down next to him in the corridor, back to the wall. "Someone told me my boyfriend got suspended this afternoon," she said lightly, "but I checked with him and figured out they were talking about you."

Max let out a short laugh he hadn't planned on, and only resented it a little.

She smoothed strays back from his forehead. "Ready to come back from crazyland now?"

His skin felt cooler where her touch had landed. "I need to know," he said, his voice dry and rough. "If I could just figure out what I did wrong…"

Simone pursed her lips. "Want a consult?" she offered.

Max was beyond pride. He fumbled and brought out the PADD with Ruth Emery's case file on it. Simone took it and scanned its contents. "Probably not authorized to have it now, anyway," he said dully.

A strange expression crossed her face, a hybrid of amusement and chagrin.

"What?" demanded Max.

She tapped the PADD on the palm of her opposite hand and Max repressed the urge to snatch it back. "You smell like coffee," she observed. "You hate coffee."

"They don't have caffeine stims in the commissary," he snapped.

"Most people like coffee better," she said reasonably. "But most people didn't grow up on Beta Cygni, where food tastes like shit and they don't have time to drink. I always saw you hit the stims around exam time."

Max felt a strange, queer looseness in his chest.

"Mining colonies," she persisted, raising her dark eyes to his, "...coffee? Or stims?"

Max said nothing.

"And when you use too many for too long, you get …" prompted Simone.

"Arrhythmia," he whispered.

"And no chemical signatures that would set off the sensors," she agreed. She pocketed the PADD.

Max felt dizzy and sick. "I could have compensated for that," he whispered. "A different stabilizer, a softer stimulant…" He trailed off.

Simone didn't correct him. There was nothing to correct.

"I think it's time for that drink," she said at last, getting to her feet and offering her hand to him. "This time, you're buying."

* * *

Max sat in the lounge of the _Paracelsus_. His four friends gathered with him to offer what comfort they could.

"Thanks," said Max in a quiet voice as the first round was delivered.

"It isss no great hardship," said Thorl. "You are an asssshole, but you have redeeming qualitiesss."

"Like free drinks," offered Owen amiably, grabbing his glass.

Simone knocked hers back and put it down with enthusiasm. "More," she ordered.

Their section of bar was littered with glasses. Thorl was losing a loud argument with the bartender over their synthehol limit. Max was in quiet, intense, drunk conference with Setat.

"Is this stupid?" he asked seriously.

Setat considered this. "Spending time with illogical sentients?"

"Getting drunk. Doesn't fix anything."

The Vulcan held his glass steady, an admirable feat. "Before I lost a patient, I did not understand the significance of this ritual. Now I do."

Thorl returned from the bartender, seething. "That fool hasss no underssstanding of the fragility of life. I should give him a demonssstration."

Simone appeared, Owen in tow. "I have a place," she said.

The world was unsteady, refracted into loud music and pinpoints of light in the darkness. Owen yelled in his ear to be heard. "...nothing personal, right? Just a thing that happened."

Something cold with a harsh bite was in his glass. He drank more of it. The world spun. He could feel the ship's engines make some tiny course correction, and it occupied the whole of his attention.

On his other side, Thorl grinned, blue face split by white teeth. "Another round," he demanded of the bartender. "My brother has a great thirssst tonight."

Max drank.

The room was bright now, the sterile whites and blues of a Starfleet isolation ward, sideways. "...never selected one," Setat's voice said calmly.

"Never mind it." Simone's voice was confident and sure. "I know what he wants."

A buzzing insect bit into his shoulder blade, but Max was too weary to move.

* * *

Awareness was much less painful than he had anticipated. Someone had given him a saline drip. Max raised his head cautiously from his bunk.

"Good timing," said Thorl. He was standing near the door, dressed for work. "I have to leave in three minutesss."

"What?" he asked stupidly.

Thorl handed him a PADD. Max recognized it as the unit he had surrendered to Simone containing Ruth Emery's file. A picture of unpleasantly pale skin, undoubtedly his, occupied the screen, decorated with a flawless Starfleet Medical crest. Around the bottom edge, where the it should have read United Federation of Planets, the words had been replaced with Latin text.

SOLA DOSIS FACIT VENENUM

"Nice lettering," he remarked, his voice steadier than he felt.

"She doesss good work," agreed Thorl. "I am to tell you that you have an important appointment in lessss than an hour with Dr. Murchada. We wrote an obsssequiousss apology on your behalf," he added with an evil smile.

"Thanks," said Max weakly.

"It isss what friendsss do," said Thorl.


End file.
